pharmacotherapy of arterial hypertension Flashcards by Janet Jincy

in arterial hypertension patient should also be advised on what other than medication ?

physical activity and dietary changes

How well did you know this?

Not at all

Perfectly

what is the classification for cardiovascular risk for patients with arterial hypertension with no concomitant condition or risk factors (smoking etc)

high normal bp (130-139) / (85-89)
= no risk

Grade 1
(140-159 )/ (90-99)
= low risk

grade 2
(160-179) / (100-109)
= moderate risk (initiate therapy from here)

grade 3
over 180/110
=high risk

How well did you know this?

Not at all

Perfectly

what is the classification for cardiovascular risk for patients with arterial hypertension with 1-2 additional risk factors

high normal bp (130-139) / (85-89)
= low risk

Grade 1
(140-159 )/ (90-99)
= moderate risk

grade 2
(160-179) / (100-109)
= moderate risk / high risk

grade 3
over 180/110
=high risk

How well did you know this?

Not at all

Perfectly

what is the classification for cardiovascular risk for patients with arterial hypertension with more than 3 additional risk factors

high normal bp (130-139) / (85-89)
= low / moderate risk

Grade 1
(140-159 )/ (90-99)
= moderate /high risk

grade 2
(160-179) / (100-109)
= high risk

grade 3
over 180/110
=high risk

How well did you know this?

Not at all

Perfectly

what is the classification for cardiovascular risk for patients with arterial hypertension with organ damage / chronic kidney disease stage 3 / diabetes mellitus

high normal bp (130-139) / (85-89)
= moderate risk / high risk

Grade 1
(140-159 )/ (90-99)
= high risk

grade 2
(160-179) / (100-109)
= high risk

grade 3
over 180/110
=high risk

How well did you know this?

Not at all

Perfectly

what is the classification for cardiovascular risk for patients with arterial hypertension with symptomatic cardiovascular disease
chronic kidney disease stage 4 or more diabetes mellitus with organ damage or risk factors

high normal bp (130-139) / (85-89)
= very high risk

Grade 1
(140-159 )/ (90-99)
= very high risk

grade 2
(160-179) / (100-109)
= very high risk

grade 3
over 180/110
=very high risk

How well did you know this?

Not at all

Perfectly

what does organ damage mean ?

asymptomatic such as RV OR LV hypertrophy

microalbuminuria

vascular damage

How well did you know this?

Not at all

Perfectly

what are the risk factors when we say additional risk factors ?

age 
male sex 
smoking 
dyslipidemia 
glucose intolerance 
obesity 
family history of premature Chronic vascular disease

How well did you know this?

Not at all

Perfectly

what re the main groups of anti hypertensive drugs ?

diuretics

blockers of RAAS:

1) ACE inhibitors
2) angiotensin receptor blocker ARB
3) renin inhibitors
4) aldosterone antagonists

calcium channel blocker 
1) dihydropyridines
nifedipine
amlodipine 
feloDIPINE
DIPINE'S
2) non dehydropyridines 
verapamil 
diltiazem

beta adrenergic blocker BAB

1) non selective
2) cardio b1 selective
3) vasodilation

alpha adrenergic blocker

central sympatholytics

How well did you know this?

Not at all

Perfectly

diuretics are further classified into ?

thiazides

and loop diuretics

How well did you know this?

Not at all

Perfectly

what are the thiazide drugs ?

hydrochlorothiazide
chlorothadilone
indapamide

How well did you know this?

Not at all

Perfectly

what are the loop diuretics ?

furosemide

torasemide

How well did you know this?

Not at all

Perfectly

what is the mechanism of action in diuretics ?

reduce the peripheral vascular resistance by vasodilation in LOW DOSES

reduce the intravascular volume in HIGH DOSES through excretion

How well did you know this?

Not at all

Perfectly

what is the antihypertensive effectiveness for diurectics ?

slight to moderate

How well did you know this?

Not at all

Perfectly

what are the advantages of diuretics to other antihypertensive drugs ?

they can be combined
they reduce left ventricular hypertrophy
decrease brain stroke

How well did you know this?

Not at all

Perfectly

diuretics are suitable and recommended for who ?

isolated systolic hypertension

elderly (FIRST CHOICE)

congestive heart failure with edema

acute heart failure - loop diuretics

renal failure - loop diuretics

How well did you know this?

Not at all

Perfectly

what are the adverse side effects for diuretics ?

hypokalaemia

LDL increase and lowers HDL transiently

increase uric acid to cause gout

increase blood sugar levels and insulin resistance

How well did you know this?

Not at all

Perfectly

chlorothalidone has an adverse reaction in men which is what ?

erectile dysfunction

How well did you know this?

Not at all

Perfectly

when is diuretics contraindicated ?

gout

pregnancy

How well did you know this?

Not at all

Perfectly

what are some of the ACE inhibitors ?

enalapril

lisinopril

How well did you know this?

Not at all

Perfectly

how are ACE hemodynamically active ?

lowers peripheral resistance

improve the endothelial function

increases bradykinin

How well did you know this?

Not at all

Perfectly

what are the advantages of ACEI

decrease LV hypertrophy

fibrinolysis

RENAL PROTECTION - decrease microalbuminurea

METABOLICALY NEUTRAL

How well did you know this?

Not at all

Perfectly

for whom are ACEI suitable for ?

diabetes mellitus

nephropathy / proteinurea - microalbuminurea

stroke / or after myocardial infraction

congestive heart failure

How well did you know this?

Not at all

Perfectly

what are the adverse side effects of ACEi ?

cough

allergy

increase risk for gout

hyperkalemia (esp when combined with other RAS )

orthostatic hypotension when combined with thiazides

How well did you know this?

Not at all

Perfectly

when are ACEi contraindicated ?

2-3rd trim of pregnancy bilateral renal artery stenosis angioneurmtic edema hyperkalemia gout

ACEI should not be combines with other RAAS inhibitors why ?

causes hyperkalemia

ACEI should not be combined with thiazides why ?

can cause orthostatic reaction

what are some ARB's?

losartan valsartan (Sartans)

what is the hemodynamic mechanism of ARB's?

lower peripheral resistance - no effect on bradykinin

what are the advantages of ARB's?

metabolically inactive decrease left ventricular hypertrophy renal protection

to whom is ARB suitable for ?

coughing with acei diabetic nephropathy / proteinurea / microalbuminurea congestive heart failure after myocardial infraction

what are the disadvantages of ARB's?

they are expensive increase risk for gout - EXCEPT LOSARTAN hyperkalemia (esp when combined with other RAAS)

what are the contraindications of ARB?

PREGANCY 1ST AND 2ND TRIMESTER hyperkalemia binary stenosis of renal artery gout

what are the aldosterone antagonists ?

spironolactone | eplerenone

what are the renin inhibitors ?

aliskiren

what is renin inhibitor suitable for ?

congestive heart failure

what are the disadvanatges of renin inhibitors ?

expensive hyperkalemia especially with KIDNEY DISEASE diarrhea

what the contraindications of aliskiren?

pregnancy chronic kidney disease kidney disease DIABETES

what is the hemodynamic mechanism of spironolactone ?

decreases cardiovascular remodelling - peripheral vascular resistance lowered ???? i dunno

what are the advantages of spironolactone ?

decreases left ventricular hypertrophy

to whom is spironolcatone useful for ?

congestive heart failure after myocardial infraction

spironolactone whorls not be used in combination with ACEI and ARB why ?

hyperkalemia

what are the contraindication of spironolactone

pregnancy hyperkalemia renal failure

how do non DHP hemodynamically active

decrease heart contractility | and peripherl vascular resiatsnce

what are the advantages of calcium channel blockers ?

metabolically inert decrease left ventricular hypertrophy decrease risk for stroke bronchodilator decrease risk for gout

when are calcium channel blockers suitable for patients ?

COPD AND ASTHMA GOUT DIABETES MELLITUS / METABOLIC SYNDROME ISOLATED SYSTOLIC HYPERTENSION INITIAL FOR ELDERLY peripheral vascular diseae

WHICH CALCIUM CHANNEL BLOCKER is given during pregnancy ?

nifedipine

which calcium channel blocker is good for supra ventricular tachycardia ?

non -DHP

which calcium channel blocker is suited atrial fibrillation ?

non -DHP

which calcium channel blocker increases the risk for acute myocardial infraction ?

nifedipine

which calcium channel blocker increases the risk for bradycardia and conduction disorders ?

Non - DHP

what is a side effect on blood vessels using non DHP's?

increased risk for bleeding

what are the contraindications for DHP?

tachyarrythmia's congestive heart failure cardiogenic shock aortic stenosis obstructive cardiomyopathy

what are the contraindications for NON dhp?

``` bradycardia arrythmia sinus syndrome congestive heart failure low BP ``` AV block congestive heart failure

what are the non selective BAB's

propranolol

what are the CARDIO b1 selective BAB blockers ?

metoprolol | bisoprolol

what are the vasodilation BAB's

carvedilol | nebivolol

how do BAB'a hemodynamically work ?

decrease rate of heart contractility decrease the release of renin

what are the advantages of BAB

cheap | long term benefit

who are suitable for BAB?

initial therapy for young adults coronary heart disease / post acute myocardial infraction migrane tachyarrythmia

which BAB is preferred in pregnancy esp for IUGR?

labetalol - non selective

locally used BAB can also help with what ?

glaucoma

what are the ARD using BAB

bronchospasm decrease HDL and increases TG bradycardia and conduction disorder INCREASE INSULIN RESISTANCE sexual disorders hypoglycemia and mask hypoglycemic signs

what is a ADR using non selective BAB

peripheral vascular spasm

compared to others why are BAB's relatively bad to

decrease let ventricular hypertrophy slower rate than the other drugs

what are the contraindications to BAB

asthma / COPD (use beta selective) AV block and bradyarrythmia peripheral vascular diseases athletes decompnesated heart failure cardiogenic shock diabetes prinzenetal angina

what are the alpha adrenergic blockers ?

praZOSIN | doxaZOSIN

what are the advantages of alpha adrenergic blockers

increase hdl improve insulin sensitivity decrease lv hypertrophy improve fibrinolysis

who are alpha adrenergic blocker suitable for ?

diabetes prostate hypertrophy lipid disorders

what re the disadvantages of alpha adrenergic blockers ?

orthostatic reactions sexual problems headache risk of CONGESTIVE HEART FAILURE S DOUBLE

contraindications of alpha blockers are ?

congestive heart failure

what are the targets for blood pressure ?

systolic BP less than 140mmhg elderly less than 150 mmhg chronic kidney disease less than 130mmhg diastolic less than 90 mmhg diastolic in DM < 85mmhg

in in grade 1 AH risk patients what kind of therapy do we give ?

low dose mono therapy

in higher risk AH2 / 3 patient what kind of therapy do we give ?

initial low dose of ditherapy of two agents

what if the therapy does not work ?

make it to full dose switch medicine two or three drug combination two or three drug combination in full dose

which two drug combinations are contraindicated ?

ACEi and ARB

which two drug combinations are preferred ?

``` thiazides + ACEI thiazides + CCB thiazides +ARB ARB+ CCB CCB+ACEI ```

what are the drugs that should be stopped capable of rising BP?

``` NSAID GLOCOCORTICOIDS COMBINEd HORMNOAL CONTRACEPTIVES COCAINE AMPHETAMINE CYCLOSPORIN ```

WHICH ANTIHYPERTENSIVE DRUGS ARE PREFFERED FOR CEREBROVASCULAR DISEAS OR COGNITIVE DISORDERS

CCB / thiazides | in combo with RAAS blockers

in elderly and DM how many combo of drug are necessary ?

ditherapy

in coronary heart disease/ hf what is considered first line therapy ?

BABS and RAAS - reduce the rate of reinfraction CCB - contraindicated

how many drug combo necessary in CKD ?

tritherapy

what is gestational hypertension ?

develops 20th gestational week without proteinuria

what is pre-eclampsia ?

develops 20th gestational week with proteinuria

drug therapy in pregnancy needed when

gestation and chronic = 150/100 pre-eclampsia = 170/110

what are the preferred drugs in pregnancy ?

labetelol , nifedipine , methydopa second choice - BABS :( possible intrauterine growth restriction and retardation hydralazine - iv asa given after 12th gestational week at high risk for pre- eclampsia magnesium sulfate iv - prevent eclampsia

at wha bp does it become hypertensive crisis ?

180/120 mmhg

in hypertensive crisis therapy should be targeted at what bp

160/100 | within 3-6 hours

hypertensive criss with organ damage goes through what therapy ?

parenteral therapy target - 25 percent less of bp within first hours then bp gradually and cautiously reduced to 160/100 and normalise in the next 24/48hr

rapid and abrupt lowering of bp can lead to what ?

brain , coronary and renal ischema

rapid lowering of bp should be avoided in all cases except ?

acute pulmonary edema and aortic dissection

in hypertensive crises what are the drug preferred

``` labetelol sodium nitroprusside nicardipine nitroglycerine enalapril ```

in hypertensive patients with diabetes what is the hb1ac target ?

below 7 percent with anti diabetic treatment statins are also recommnended for moderate to high cv risk

patients with reduced renal function and HIGH CV risk (not mild to moderate) should be recommended what ?

antiplatelet - aspirin

whata re the centrally acting sympatholytics

clonidine methyl dopa rilmenidine